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The field of the invention is medical imaging methods and systems. More particularly, the invention relates to a standard system which can be used to interface with any of several different imaging system types.
Traditionally medical facilities have concentrated their efforts on providing the best possible medical services to patients. One area in which the quality of medical services has progressed extremely quickly is in the medical imaging disciplines or modalities which include radiography, fluoroscopy, angiography, magnetic resonance (MR) imaging, ultrasound, nuclear medicine (NM) and computer tomography (CT).
While each of the separate imaging modalities can be used to generate medical images, the medical imaging industry has recognized that each modality is particularly suited for certain imaging techniques and that some modalities are better suited than others for observing specific anatomical phenomenon. For this reason, many medical facilities have acquired a plurality of imaging systems, each of which facilitates a different one of the imaging modalities. This is particularly true in large medical facilities which may have several imaging systems for performing each of the imaging modalities (i.e. several MR systems, several CT systems, etc.). Having several imaging systems each capable of facilitating a different one of the imaging modalities enables a physician to select the best imaging modality for a particular imaging task and therefore increases the usefulness of a resulting image for achieving the particular task. In fact, many medical facilities compete for patients based on the abilities of their medical imaging departments. This imaging department competition places pressure on each medical facility to maintain state of the art imaging departments.
While imaging system quality has increased appreciably, the costs associated with maintaining a state of the art imaging department have also increased appreciably. Unfortunately, despite increased costs associated with providing a state of the art imaging department, recently there has been mounting pressure on many medical facilities to reduce medical costs. For this reasons imaging departments are always looking for ways to decrease department costs while maintaining the highest possible service quality.
In addition to imaging hardware and software costs which are substantial, another expensive component to any successful medical imaging department is imaging personnel which includes radiologists and technologists. A radiologist is a trained physician who specializes in radiology disciplines and typically in other imaging modalities. Technologists are supervised by the radiologists and perform most of the setup, imaging, filming and archiving of images.
Basic training for a technologist in the imaging disciplines typically includes two years of on the job apprenticeship which focuses on the human anatomy and physiology, imaging equipment theory and operation and imaging procedures. In addition to basic training, many technologists obtain additional training in imaging specialties such as ultrasound, NM and radiation therapy. Training in each specialty typically takes about an additional year per specialty. In addition, some technologists obtain further training in sub-specialties such as computer tomography CT, MR and angiography, each of which requires further on the job training. After a successfully completed apprenticeship a technologist performs procedures under the direction of a radiologist.
Because of the differences in the imaging modalities, many medical facilities are staffed with a plurality of technologists, at least one technologist for each imaging modality practiced at the facility. Thus, in some cases a facility may include at lease seven technologists, at least one technologist for each possible modality. While necessary to have a trained technologist in each imaging modality practiced at a facility, such staffing requirements are extremely expensive.
One solution to the excessive technologist staffing problem has been to train technologists in more than a single imaging modality. For example, one technologist may be trained in both NM and CT while another may be trained in fluoroscopy and radiography.
Another solution to the excessive technologist staffing problem has been for medical facilities to share technologists. Thus, for example, a CT technologist may divide her time between three separate medical facilities, every third day spent at a different one of the three facilities.
While both of these solutions reduce costs associated with technologist staffing, each of the solutions is hampered by the current state of imaging systems and the way in which technologists are forced to interact with such systems and system information. An exemplary MR imaging session is instructive in understanding the difficulties associated with training a technologist in more than a single imaging modality.
A typical MR imaging session comprises several different steps including scheduling, analyzing patient information, patient preparation and handling, acquiring image data, displaying images, advanced processing of image data, filming display images, archiving display images, logging completed acquisitions and interpretation and reporting. Each of the different steps often requires a technologist to interact with one or several different department tools. For example, during scheduling a technologist typically uses a scheduling clipboard (i.e. paper on a clipboard) or the like to schedule imaging sessions during the coarse of a day. A scheduling table appears on the board which typically identifies time, patient, the type of exam required (e.g. C-spine, brain, head, etc.), status, identification number, etc.
As an alternative to a hardcopy clipboard, some facilities now have automated scheduling tools whereby a scheduling computer is used to generate a scheduling table which is consulted by the technologist throughout the course of a day to schedule and keep track of required imaging tasks.
In addition to the scheduling table, often a hardcopy (i.e. paper) requisition form will be provided for the technologist which includes additional patient identifying information (e.g. weight, height, sex, etc.), may list allergies, identifies the type of exam (e.g. c-spine, brain, head) to be performed, identifies the requesting physician and so on. Prior to imaging a requisition form is required to ensure that inadvertent imaging is not performed on patients. Once again, some automated facilities provide a computer for accessing requisition forms.
After examining a requisition form and confirming authorization and prior to meeting a patient, the technologist typically confirms images which have to be acquired during a subsequent session. For example, while imaging a spinal section using the MR modality, it may be conventional to obtain a series of image slices along the length of the spinal section using a T1 FSE pulse sequence and a T2 FSE pulse sequence. In addition, a particular physician may routinely require a third series of image slices using an oblique axial FSE pulse sequence. To confirm required images technologists often consult a required image guidebook which includes lists of required images and may include lists of images specially required by specific radiologists. In addition, a guidebook may also indicate required patient position and equipment position for each required image Moreover, each facility may also have a list of standard required images which must be consulted by the technologist.
During patient preparation and handling, the technologist greets the patient, explains the imaging procedure, helps the patient onto an imaging table and guides the patient into a first position required to collect a first of the required images.
Next, during acquisition the technologist typically uses an acquisition computer to select specific images to be generated by selecting image boundaries and image parameters. To this end the technologist often will acquire one or more localizing images which can be used to generally identify the position of anatomical structures within a patient""s body. Viewing the localized image the physician selects required images to be generated and can select imaging parameters to use when generating the required images.
Typically there are many different imaging parameters which can be selected and adjusted. In an effort to make acquisition computers easy to use, many acquisition computers provide an interactive interface including parameter icons for use with a pointing device to enable a technologist to select icons and change parameters with the click of a pointing device button (e.g. a mouse) or via a keyboard. To notify a technologist of all selectable parameters and iconic parameter selecting tools, interfaces of this type display virtually all parameters and associated icons on the interface for examination selection.
In addition, to help a technologist select appropriate parameter settings the imaging guidebook may also include tables indicating standard parameter settings for each image to be formed. These standards may be selected by the facility generally and may also include specific required settings for each requesting radiologist. After selecting parameters the technologist causes the imaging system to acquire the selected images, the system storing the images electronically.
Next, the technologist may reposition the patient in a position optimal for collecting data for the second required image and thereafter follows the same procedure described above to collect required image data.
After required images have been stored electronically the images are downloaded onto an archive system which typically includes a second computer in addition to the acquisition computer. By downloading digital images to a second computer the acquisition computer is freed to perform a subsequent image acquisition. Many acquisition computers enable both archiving and acquisition at the same time so that, while image data corresponding to one patient is downloaded to the second computer, image data corresponding to another patient can be collected. This simultaneous dual function ability increases the throughput rate (i.e. patients/day) for the imaging system and thus overall efficiency.
After the images are downloaded to the second computer, the technologist can use the second computer to analyze the images and perform advanced image processing. Thus, for example, where ten parallel and adjacent MR images have been collected which define a three dimensional data array, a technologist may want to generate a maximum intensity projection (MIP) using three of the ten images. To this end the technologist selects the three images to form the MIP and instructs the second computer to combine the three images to form the MIP. Other advanced processes are possible and are contemplated.
After advanced processing the technologist may select all or a subset of the original or advanced process images for generating film hardcopies for physician review. After selecting images for filming a filming machine, which is also controlled and maintained by the technologist, is used to generate required film pictures. After filming the pictures are provided to a physician for examination and thereafter are archived in a patient""s file. In addition to filming, some systems also enable digital archiving so that digital images can be reaccessed using a computer or the like for review or for subsequent advanced processing.
After a completed imaging session the technologist typically uses a binded logbook notebook to document the completed session by indicating the date, time, patient name and number, examination type and so on.
Thus, for a specific modality a technologist has to interact with several specific tools including a schedule, requisition forms, an image guidebook, an acquisition computer, a second advanced processing computer, a filming machine, an archiving database and a logbook.
While learning to use these tools for a single modality is not terribly difficult, differences between similar tools used for different modalities complicates the process of becoming proficient in two or more modalities. Thus, for example, scheduling clipboards for one imaging system may be set up entirely differently than scheduling clipboards for another imaging system. Even where two imaging systems are both automated to include scheduling computers and even where each of the two automated systems are provided by the same vendor, each computer usually includes a different interface such that entry of scheduling information into the two computers is in a unique sequence and different information may be required for each system.
Similarly, each system may have an entirely unique type of equisition form such that locating form information is a tedious task. This is true of both paper forms and automated computerized systems.
Moreover, imaging guidebooks may be relatively complex and can become difficult to use as radiologist""s particular requirements are added to the books. For example, at a large medical facility there may be more than 10 radiologists who routinely require MR imaging. While each of the radiologists typically will require some identical images when a specific exam type structure (e.g. c-spine) is performed, many of the radiologists may require additional specific images which the particular radiologist finds helpful during diagnosis. In addition, while, for each required image there might be a typical patient position which is usually used to acquire the image, each radiologist may also have a slightly different preferred position which, in the radiologist""s judgment, yields a slightly better final image. In addition, where radiologist""s require specific system parameter settings the technologist also has to consult imaging guidebook tables to determine required settings. Thus, a complete imaging guidebook would have to indicate, for each radiologist, required images for each body structure, where applicable, specific required patient positions for each required image and required parameter settings for each image.
Clearly, using imaging guidebooks is tedious work. Unfortunately, the difficulty of using such guidebooks is exacerbated by the fact that many of the guidebooks have unique forms, some systems include two or more guidebooks and many guidebooks can be supplemented as radiologists are added to or removed from the facility staff.
Moreover, acquisition computer interfaces are often very different and therefore, knowing how to use one interface does not render another interface intuitive. For example, the acquisition computers for a MR system and a CT system often have extremely different interfaces which require a technologist to step through very different protocols. This is not surprising as the parameters which have to be selected for different modalities often are different. However, the tools provided for setting even similar parameters on two different imaging systems often have a very different appearance and different operation. Thus, for example, to increase a displayed parameter value one interface may require a user to place a cursor in a parameter box and type in a desired value. Another interface may include up and down arrow icons adjacent a parameter box with a current parameter setting displayed in the box, the setting increased by selecting the up arrow via a pointing device.
Acquisition computer differences are exacerbated by the fact that most system interfaces are extremely cluttered as virtually every possible tool for setting acquisition parameters is usually provided on the interface screen, this despite the fact that many tools are only rarely used by the technologist. While designed to help a technologist by indicating all possible tools it has been recognized that such a crowded screen actually reduces technologist efficiency as the locations of the most widely used tools are obfuscated.
Furthermore, the interfaces and operation of the advanced processing computers, filming machines and archiving computers for different processes (i.e. modalities) are also often very different.
All of the interfacing problems described above are exacerbated where a single technologist works between facilities as facility unique interfaces, guidebooks and schedules have to be decrypted by visiting technologists prior to efficient system use.
An exemplary embodiment of the invention includes a universal interface usable with at least first and second different imaging modalities, each modality including functions or procedures which are common to each of the first and second modalities, each separate instance of the interface used with only a specific one of the first or second modalities. The interface comprises a display, a programmed data processor for providing a uniform interface image on the display despite the specific modality, the uniform interface image comprising a function navigation space including function icons corresponding to procedures which are common to both the first and second imaging modalities and a workspace adjacent the function navigation space for displaying, analyzing and manipulating images of a type consistent with the specific modality and a pointing device for moving a pointer icon about the display and for selecting displayed icons. When an icon is selected, the processor correlates the selected icon with a corresponding command and executes the command.
The universal interface facilitates fast training of technologists thereby enabling inexpensive cross-modality training and technologist substitution. To this end, it has been recognized that there are several basic system processes which are common to each of the known imaging modalities. The universal interface is structured around the basic processes to provide a feeling of comfort to a technologist proficient in any imaging modality.
It has also been recognized that, for each basic process, there is often a typical sub-process workflow which is routinely followed. Thus, preferably, each procedure which is common to the first and second modalities includes procedure specific sub-processes and the workspace includes a workflow navigation space in which, when a function icon is selected, the processor displays a workflow icon set including a separate workflow icon corresponding to each sub-process of the process associated with the selected function icon and for the specific modality. On each modality interface each of the navigation space and workflow space are similarly positioned and similarly color coded to further render a technologist comfortable using each interface.
Moreover, the invention includes one or more data tables which are accessible by an acquisition computer for guiding a technologist through the process of determining required images and patient positions, setting proper imaging parameters for each required image and selecting desired advanced imaging processes.